Thursday, September 12, 2019

Self Determination Program

Self Determination Program
September 2019

In previous blogs, I explained how the California Regional Center System provides long-term medical expenses including personal assistant services, durable medical equipment, long term therapies, and maintenance drugs to people with developmental disabilities regardless of their income or assets. Now the Regional Center System is implementing a Self Determination Program (SDP). This program should be the model for providing Independent Living Services to all people with disabilities in all states!

The Self Determination Program will enable participants to have control of their annual Independent Living Services budget and manage their own personal assistant services, as well as their educational, vocational, and community involvement plans. Participants are required to use a Financial Management Service (FMS) to perform financial matters. The FMS may be used just to pay bills, or be a co-employer with the SDP participant, or be the employer-of-record for the SDP participant's staff. The SDP participant is required to create and maintain an annual Person-Centered Plan (PCP) where they outline their goals and objectives and explain how their budget will be used to achieve their plans. Participants may hire independent facilitators to help them prepare and follow through with their projects and budgets. Participant's Regional Center's caseworker will review plans and budget to help to ensure they meet labor laws, SDP guidelines and that nothing has been omitted.

Currently, Denise and I get our personal assistant services through Thrive Support Services. They have been great to work with. They enable us to find, train, and manage our own attendants. We have created our own Self Determination Program. It will be useful to have full control of our budget and our attendants' schedule and not be constrained by some of the rules a Supportive Living Services Provider must enforce. For example, our attendants must clock in and out from within our house. I am hoping Thrive Support Services will be our Financial Management Services Provider when SDP starts.

To date, the Regional Center of the East Bay (RCEB) has focused mainly on preparing participants on how to create PCPs. More emphasis is needed on the financial and liability aspects. Participants that use personal assistant services need to have guidelines regarding wages, fringe benefits, training, time off, emergency services, insurance, etc.

Currently, many people with disabilities are unemployed and live in poverty as a way of qualifying to receive healthcare and long-term medical expenses they need to survive. Given that the government is already paying these expenses, it is hypothesized that rolling out a Self Determination Program to everyone that needs it may not incur more costs. If more people with disabilities become employed, the taxes they pay may result in overall cost-savings. Providing the Self Determination Program to people with mental health disabilities may be one way of combating the homelessness crisis many cities are facing, especially if independent facilitators and personal assistants are available and well trained.

I have a great deal of hope that the Self Determination Program is the next major accomplishment for the Disability Movement. Let me know what you think. How can we promote this program?

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Sunday, July 28, 2019

Hate, Diversity, and Assimilation

August 2019

As of 08/04/2019, there have been 250 mass killings in this country this year! Now, more than ever before, we need leaders who unite us. I urge everyone, especially our President, to stop all the divisive rhetoric. While it is true that the shooters are the ones to be blamed and that they may be 'sick,' there can be no excuse for people who embolden them and flame their violence. Unless a group purposely aims to harm another group, no one should ever fear or hate others because of their sex, race, nationality, religion, sexual orientation, disability, economic class, or political association.

History has shown that when people feel financial and/or socially threatened, they seek a strong leader and a common enemy. Our President has shown us how thoroughly frightened many people are today. People are frightened by the jobs they have lost or the lives they may soon need to change. These economic and social shifts are due to advances in technology and globalization. Instead of focusing on the positive side of how these advances can help everyone, both sides of the political spectrum are instilling fear and hatred. Instead of finding ways of using new technology to ensure that everyone has good food, health, and happiness, we focus on how new technology is taking away our jobs and privacy. Instead of seeing how globalization can supplement and complement our cultures, we choose to blame each other for the atrocities of the past.
Focusing on diversity and neglecting assimilation has led to a very ugly and dangerous tribal polarization in this country. It is critically essential that people in all ethnic, racial, national, and other cultures learn about their heritage and feel good about their group and good about who they are. It is equally essential that all people learn how to assimilate into the mainstream culture. Accusing 'the other group' of the horrors, pain and discriminating acts they and their ancestors have afflicted on 'our group,' regardless of the validity of the accusation, rarely lead to real change. Working and playing and focusing on how changes will help everyone is how actual progress happens.

I have an obvious and palpable disability. I use a powered wheelchair for my mobility. I cannot sit up straight. Cerebral Palsy causes involuntary body and facial movements. I have a significant speech impairment. I have always been a strong disability advocate. The Disability Movement has resulted in many great civil rights laws and a much more physically accessible nation and world. My disability advocacy successes have come from my active participation with my family, friends, and the Jewish and business communities. Here are 2 examples;

After working at Wells Fargo for a year, I needed something from the data center. At that time, the data center was just a few floors below where I worked. I called, and the person who answered the phone made fun of my speech and hung up. I tried again, and the same thing happened. I told my manager what happened. My manager was livid. He wanted to get the operator reprimanded and fired. I asked my manager to simply let me know the name of the operator. Knowing the operator's name, I went down to the data center. When I got there, several people who knew me came over to say hi and find out what I needed. After getting my question answered, I ask them to tell me who so-and-so was. They pointed to him. He turned and faced me. He turned pale. I said, “Hi, how are you?” and left, He became one of my best allies.

Often at Wells Fargo, I attended meetings where many of the attendees didn't know me. I was amused by seeing the fear on their faces as they saw me for the first time. The air in the room sometime was very thick due to their anxiety. If I led the meeting, I'd say something like, 'for the next few minutes, you probably won't understand what the hell I'm saying because of my New York accent – haha). As the meeting progressed and we started talking about work, I loved seeing faces relax and the air clear as they forgot about how different I looked and sounded.

I am extremely fortunate to have parents who knew the importance of assimilation. Being survivors of the holocaust, they worked very hard to assimilate into America's culture while always remembering their Jewish heritage and advancing their Jewish culture. They demonstrated how people can assimilate without conforming. Assimilation is fitting in by emphasizing commonalities and positivity. Conforming asks people to change who they are and what they believe. My parents
always told me that due to my disability, I had to be better and work harder than people without disabilities. The way people viewed and reacted to me was my problem and my responsibility to change. 

Blaming others for their feelings and sins of their heritage too often diminishes our ability to affect real change. Burdening marginalized individuals with continually having to combat negative stereotypes and discrimination is difficult and unfair. Diversity awareness training must continue. However, more emphasis needs to be made to ensure that people feel good about themselves, be proud of the group(s) they identify with and have the skills to assimilate with others. True diversity will happen as we work, play, and interact with each other.
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Monday, July 15, 2019

A Plan to Achieve Healthcare For All

July 2019

It's great to see that most people in this country recognize the necessity of having healthcare for all. This blog suggests that a Central Healthcare Agency and Marketplace (CHAM) is needed. Some of the goals and objectives of a CHAM include:
  1. Ensuring everyone has access to excellent and affordable healthcare, including Long Term Support Services.
  2. Setting standards and price ranges for healthcare products, services, and insurance plans that are subsidized.
  3. Ensuring that no one needs to pay more than a percentage(5%?) of their annual income for healthcare premiums and no more than an additional rate (5%?) for their total yearly healthcare costs.
  4. Enabling the private sector to provide healthcare products, services, and insurance plans that meet and surpasses standards set by CHAM. Anyone willing and able to pay healthcare costs that exceed CHAM's standards can do so.
  5. Ensuring that healthcare costs are sufficient to
    1. attract people to healthcare jobs and professions,
    2. continually improve products, services, and facilities, and
    3. promote innovation, research, and ever-increasing quality of care.
  6. Enabling employers and other third parties to offer healthcare plans either through their chosen vendor and/or by contributing to an individual's CHAM account.
  7. Confirming that most people all along the wealth spectrum see the system as equitable.
  8. Encouraging competition and healthcare investments.
  9. Ensuring that the system is economically self-sustainable.
The CHAM will set minimum standards for healthcare and long term support services. State and/or community CHAM boards will establish price ranges for all products, procedures, drugs, and other commodities associated with these services. Price ranges will also be set for healthcare plan expenses, including premiums, deductibles, copays, and out-of-pocket expense caps.

Private and public enterprises will sell their healthcare plans through CHAM. Each plan must offer all of the minimum set of healthcare products and services set forth by CHAM. Enterprises that currently don't provide the complete set should collaborate with other enterprises to ensure comprehensive healthcare and long term support services are available to everyone.

Individuals and households will sign up to be members of CHAM. Members will be charged monthly premiums that are a percentage (5%?) of their taxable income. Members total annual out-of-pocket healthcare expense will be capped at an additional rate (5%?) of their taxable income. Members choose any healthcare plan they want. CHAM pays all healthcare charges that meet CHAM standards and are within CHAM's price ranges. Members can select programs whose healthcare plans expenses exceed CHAM's ranges by waiving CHAM's responsibility to subside any of the member's healthcare charges for that enrollment period. Members will be charged for deductibles and copays up to their annual out-of-pocket expense cap. Members will also be charged for products and services that are not covered by CHAM standards or exceed CHAM's price ranges. See examples below.

This proposed plan needs to be vetted by healthcare professionals, the general public, economists, healthcare plan managers, healthcare insurance carriers, and legislators to ensure that the goals and objectives listed above are met.

I look forward to your feedback.
Re Healthcare Premium

CHAM's member's premium cap = 5% of taxable income
CHAM's price range for premiums = $0 - $400

  1. Example 1
    1. Characteristics
      1. Member taxable income = $10,000
      2. Healthcare premium = $200
      3. Member does not waive CHAM subsidy
    2. Member Pays $500 for premium (5% of $10,000)
    3. CHAM Pays $0 subsidy for premium

  1. Example 2
    1. Characteristics
      1. Member taxable income = $1,000
      2. Healthcare premium = $200
      3. Member does not waive CHAM subsidy
    2. Member Pays $50 for premium (5% of $1,000)
    3. CHAM Pays $150 subsidy for premium

  1. Example 3
    1. Characteristics
      1. Member taxable income = $10,000
      2. Healthcare premium = $550
      3. Member has to waive CHAM subsidy or choose a different plan
    2. Member Pays $550 for premium
    3. CHAM Pays $0 subsidy for premiums

  1. Example 4
    1. Characteristics
      1. Member taxable income = $10,000
      2. Member does not waive CHAM subsidy
      3. Healthcare premium = $550
    2. Member Pays $550 for premium
    3. CHAM Pays $0 subsidy for premiums

Thursday, July 11, 2019

The Need for Long Term Support Services

The Need for Long Term Support Services

      Any healthcare plan that purports to be available and affordable for everyone should include provisions for long-term medical expenses, aka Long Term Support Services. These services include such things as personal assistant services, durable medical equipment, long term therapies, and maintenance drugs. The California Regional Center System can serve as a model for this.

      For many people with disabilities, Long Term Support Services can be very costly. In recent years, personal assistant services expenses for me, and my wife exceeded $100,000 annually.

      Currently, Medicaid is the only healthcare plan that funds long-term medical expenses that are expected to be needed more than a few years. Medicaid is only available to people living at or near poverty levels. Many people with disabilities don't work for fear of losing healthcare and Long Term Support Services they need to survive. They remain beneficiaries of the Supplemental Security Income (SSI) or Social Security Disability Insurance (SSDI) Programs primarily to qualify for Medicare and Medicaid. 

      Many programs aim to assist people with disabilities to attain employment and receive the services they need. They differ by state, county, and city. They are administered by different public and private agencies. They depend on many factors, including beneficiaries' age, disability, income, assets, onset age of impairment, the reason for disability, military status, etc. These programs are very interdependent and often are too complicated for people to understand. There are many experts, websites, and businesses that try to help people through these 'disability benefits' labyrinths.

      Unfortunately, there is no comprehensive process for people with disabilities to ensure our financial health and get the Long Term Support Services we need. As an example, it was only 5 years ago that one of my attendants pointed out that my wife and I, who both have Cerebral Palsy, qualify to be California Regional Center System clients. This agency funds Long Term Support Services for people with developmental disabilities, regardless of income or assets, if no other agency does so. Cerebral Palsy is a developmental disability.  I think I am well connected in the disability community and pretty knowledgeable about disability-related programs. Not realizing the advantages the Regional Center System offers illustrates the need for a simple-to-understand universal healthcare system that includes Long Term Support Services.

       Annually, millions of dollars are spent trying to improve employment opportunities and the financial health of people with disabilities. It would be interesting to understand what affect simply enabling this cohort to keep their Medicare and Medicaid regardless of the income or assets they garnered. Given the dismally low number of people who leave Social Security Disability Programs due to finding gainful employment, it is surmised that any increase in Medicare and Medicaid cost may be offset by increased tax revenue and savings in other government programs. 

      It is encouraging to see that most people in this nation now recognize the need for universal healthcare. Long-term medical expenses must be an integral part of any healthcare system.

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July 2019

Monday, March 11, 2019

Disability-Related Financial Management System

Disability-Related Financial Management System (DFMS)

There is a need for financial advisors, disability benefits experts, and AI developers to develop a comprehensive Disability-Related Financial Management System. Combining artificial intelligence,(AI), a search engine, automation, and human experiences is the only way a genuinely comprehensive Disability Finance Knowledge-Base can be implemented and kept current. A public forum will enable people with disabilities, their family and friends and support group to obtain answers from the knowledge-base as well as other people in the forum. Ratings of responses by forum members will ensure the knowledge-base continues to have the most accurate information. The DFMS will include AI-driven questionnaires and bots that will assist users in building and maintaining budgets that will maximize their chances of financial stability and success. Financial advisors will also be available.

Disability benefits are complex. People have compared it to business payroll but many times more complicated. With business payroll, every state, county, and city has its own rules that may be affected by healthcare plans, retirement plans, savings plans, etc. Disability benefits to differ by state, county and city. Many agencies and corporations offer disability benefits also. Disability benefits depend on many factors including beneficiaries' age, disability, income, assets, onset age of disability, the reason for disability, military status, etc. With business payroll, there are systems built to shield the complexities from businesses. No subject matter expert would be expected to know all that is involved with business payroll without using a system. Yet with disability benefits, we do rely on subject matter expert to know and how people with disabilities can get financing for the products and services they need. To date, our efforts with artificial intelligence are to try to mimic what disability benefits subject matter expert does. We need a system that will comprehensively discover where and how people with disabilities can finance the products and services they need.

There are many good forums re disability benefits see Social Security Forum1 as an example. There are calculators that help people with disabilities understand disability benefits. As an example, see WID's DB1012. There are courses on disability benefits including a certification process. There are books written to help people with disabilities improve their financial health. Tom Foley wrote EQUITY-Asset-Building-Strategies-Disabilities-Empowerment3. All of these are great resources based on the knowledge of subject matter expert. None uses a comprehensive, systematic approach.
In the past few years, I have been receiving funding from the California Regional Center for my personal care attendants. For decades, Denise and I spent many thousands of dollars annually for personal assistant services. It wasn't until one of my attendants ask me why I wasn't receiving services from the Regional Center did I realize that people with developmental disabilities can receive personal assistant services paid for regardless of income or assets. I have always been well connected with the Disability Community. If I didn't realize this benefit was available to me, imagine how unaware the general public must be of the many products and services that are available to them.

Many surveys have been done to understand the financial health of households that have one or more people with disabilities in them. Every study confirmed that the Disability Community has many unique financial needs that are not being met. Programs that provide financial assistance to offset the high cost of living with a disability can be challenging to navigate resulting in funds and resources not being received or maximized. Many people with disabilities do not work because of the fear of losing the benefits they need. Accessing resources and financial support available while staying within guidelines to avoid interruption of benefits is confusing and time-consuming. Budget management on a “fixed income,” much less planning for the future for needed areas like estate planning is demanding, especially without tools and guidance. Many customers with disabilities and their support networks are unaware of resources that can help them with financial management and financial planning. They are unaware that there are financial products that would be effective in specific financial stages, such as educational loans for special education, home loans for modifications, or assistive technology (equipment) loans.

With an effective Disability Financial Management System, a very necessary and profitable business can be established.

Please let me know if you have any questions. Please let me know if you or anyone you know may be interested in investing and/or managing this exciting endeavor.

Go! Go! Go!


Abilicorp 2019

Everyone, including people with disabilities, should have the skills, products, and services they need to work to the best of their abilities.
Abilicorp mission is to initiate and promote new companies and programs that provide financial advice and management enabling people to work and reap the stability and rewards that come with earning an income.
Neil Jacobson, founder, and CEO of Abilicorp retired in 2008 as a Wells Fargo Sr. Vice President after working in their IT area for more than 29 years. Neil has significant disabilities caused by Cerebral Palsy. He has been active in the Disability Movement all through his life focused primarily on improving employment opportunities for people with disabilities.
The U.S. federal government spends more than $100 million annually trying to improve the economic condition of people with disabilities and their families. Wonderful laws such as the Americans with Disability Act that have significantly improved the lives of people with disabilities. Many agencies work extremely hard trying to get people with disabilities jobs. Despite all this, the unemployment rate for this cohort remains relatively unchanged from the 1960s. More than 70% still live below the poverty level. (see The Need for a New Business Model)
The underlying cause for this lack of economic improvements is that people with disabilities are not receiving the skills, products, and services they need. Many public and private agencies run programs designed to provide these necessities. They are tough to find. Qualifying for them can be challenging. The interrelationships between the programs are often extremely complex.
The gig economy is now compounding these problems. In the gig economy, every independent worker must learn how not to feel isolated. Often finding themselves alone in front of a computer or smartphones they must learn to find mentors to help guide them. They must create their own daily structures. With no training or experience, they are expected to do things such as pay taxes, save for retirement, pay for healthcare, save for sick days and vacation days. People with disabilities must also learn how working for themselves will affect their ability to pay for long-term medical expenses including personal assistant services, durable medical equipment, long-term therapies, and maintenance drugs. Perhaps most importantly, independent workers must learn how to market their products and services effectively. (see The Gig Economy)
What does Abilicorp provide?
  1. Financial advice for independent workers
  2. Development consultation of disability-related financial management tools
  3. Promotion of Disabled Owned Business Enterprises
What Businesses Should Be Started?
  1. Financial Management for GIG Workers
  2. Financial Management of Disability-Related Expenses
  3. Remote Assistance
  4. Your Legacy
  5. Archiving
  6. Creating Audio Books for Authors
Blogs will be written describing these and other exciting initiatives. These services and businesses will be owned, managed, and delivered by self-employed people with disabilities and Disabled Owned Business Enterprises. Please let me know if you or anyone you know may be interested in investing and/or managing any of these endeavors.

Friday, March 8, 2019

DRFM Knowledge-Base

Disability-Related Financial Management Knowledge-Base (DFMKB)

Having a disability can be very costly. Disability-related expenses include:
  1. personal assistant services,
  2. durable medical equipment,
  3. long term therapies,
  4. maintenance drugs
  5. wage replacement
  6. adaptive equipment
  7. accessible transportation
  8. home accessibility improvements
  9. workplace accessibility improvement

Many government and non-government agencies offer disability benefits to pay for these expenses. These disability benefits are often based upon a person with a disability's attributes including;
  1. where the person lives (U.S., state, county, city)
  2. age (<18, 18-26, 27-64, >64)
  3. disability ( developmental disabilities, visual disabilities, deaf or hard of hearing, spinal cord injuries, autism, mental health, cognition, emotional, drug addiction
  4. reason for disability (work related, crime-related, military related, accident, birth, genetic, aging)
  5. disability onset age (birth, <18, <27, 27-65, >65)
  6. work status (never worked, working, “on disability,” retired
  7. income
  8. assets

Each disability benefits from each agency usually have its own conditions including;
  1. Definition of products and services offered
  2. Definition of terms
  3. Eligibility criteria for beginning to receive a disability benefit
  4. Criteria for continuing to receive a disability benefit
  5. Application process
  6. Reporting requirements
  7. Restrictions
  8. Exceptions
  9. Interrelationships with other disability benefits and agencies

A comprehensive systematic approach is needed to build a Disability-Related Financial Management Knowledge-Base (DFMKB) to understand which disability benefits are available to an individual given his/her needs and attributes, and the conditions under which the disability benefits can be recognized.
Most, if not all, of the information, can be found on websites. Using AI, the Google Search Engine, the Disability Financial Management Forum, and disability benefits subject matter experts, this can be accomplished. Using the DFMKB, providing financial advice to the Disability Community can be a profitable business.

Please let me know if you or anyone you know may be interested in investing and/or managing this exciting endeavor.